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Hyperkalemia in adults

Last reviewed: 22 Sep 2025
Last updated: 27 Sep 2023

Summary

定义

病史和体格检查

其他诊断因素

  • muscle weakness
  • generalized fatigue
  • paresthesia
  • muscle cramps
  • flaccid muscle paralysis
  • bradycardia
  • nausea and vomiting
  • diarrhea
  • shortness of breath
  • chest pain
  • palpitations
  • extrasystoles
  • cardiac pauses
  • tachypnea
  • depressed or absent deep tendon reflexes
  • hypoactive or absent bowel sounds
完整详情

危险因素

  • kidney dysfunction
  • heart failure
  • use of renin-angiotensin-aldosterone system inhibitors (RAASi)
  • use of aldosterone antagonists
  • use of trimethoprim
  • liver disease
  • tissue breakdown
  • distal renal tubule defects
  • diabetes mellitus
  • diabetic ketoacidosis
  • use of other drugs that cause hyperkalemia
  • increased intake of potassium
  • metabolic acidosis
  • digoxin (digitalis) toxicity
  • primary adrenal insufficiency
  • hyperkalemic periodic paralysis
完整详情

诊断性检查

首要检查

  • serum potassium
  • 12-lead ECG
  • blood gas
  • CBC
  • plasma glucose
  • renal chemistry
  • serum calcium
完整详情

需考虑的检查

  • uric acid and phosphorus
  • creatine kinase
  • serum digoxin level
  • cortisol and aldosterone levels
  • 24-hour urine potassium excretion
  • plasma and urine potassium and osmolality
  • urine pH
  • plasma renin activity
完整详情

治疗流程

急症处理

acute hyperkalemia with potentially life-threatening features

acute hyperkalemia without potentially life-threatening features

持续性治疗

chronic hyperkalemia

撰稿人

作者

Sri G. Yarlagadda, MD

Associate Professor

Kidney Institute

The University of Kansas Medical Center

Kansas City

KS

利益声明

SGY declares that she has no competing interests.

同行评议者

Manish Suneja, MD

Professor

University of Iowa and Carver College of Medicine

University of Iowa Hospitals and Clinics

Iowa City

IA

利益声明

MD receives royalties from McGraw Hill as editor of DeGowin's Diagnostic Examination.

Annette Alfonzo, MbChB, MRCP, MD

Consultant Nephrologist

Victoria Hospital

Kirkcaldy

Fife

UK

利益声明

AA declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Alfonzo A, Harrison A, Baines R, et al; UK Kidney Association (formerly the Renal Association). Clinical practice guidelines: treatment of acute hyperkalaemia in adults​. June 2020 [internet publication].全文

Rafique Z, Peacock F, Armstead T, et al. Hyperkalemia management in the emergency department: an expert panel consensus. J Am Coll Emerg Physicians Open. 2021 Oct;2(5):e12572.全文  摘要

Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021 Apr;161:152-219.全文  摘要

Clase CM, Carrero JJ, Ellison DH, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference. Kidney Int. 2020 Jan;97(1):42-61.全文  摘要

Rossignol P, Legrand M, Kosiborod M, et al. Emergency management of severe hyperkalemia: guideline for best practice and opportunities for the future. Pharmacol Res. 2016 Nov;113(pt a):585-91.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Hyperkalemia in adults images
  • 鉴别诊断

    • Pseudohyperkalemia
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  • 指南

    • Hyperkalemia management in the emergency department: an expert panel consensus
    • Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference
    更多 指南
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